Electrospun multifunctional nanofibrous mats loaded with bioactive anemoside B4 for accelerated wound healing in diabetic mice.

With the worldwide prevalence of diabetes and considering the complicated microenvironment of diabetic wounds, the design and development of innovative multifunctional wound dressing materials are much wanted for the treatment of hard-to-heal wounds in diabetic patients. In the present study, anti-inflammatory ingredients loaded with nanofibrous wound dressing materials were manufactured by a promising blend-electrospinning strategy, and their capability for treating the diabetic wound was also systematically explored. A polymer blend consisting of Chitosan (CS) and polyvinyl alcohol (PVA) was electrospun into CS-PVA nanofibrous mats as control groups. In the meanwhile, a bioactive ingredient of Chinese medicine Pulsatilla, anemoside B4(ANE), with different contents were loaded into the electrospinning solution to construct CS-PVA-ANE nanofibrous mats. The developed CS-PVA-ANE wound dressing materials exhibited multifunctional properties including prominent water absorption, biomimetic elastic mechanical properties, and sustained ANE releasing behavior, as well as outstanding hemostatic properties. The in vitro studies showed that the CS-PVA-ANE nanofiber mats could significantly suppress lipopolysaccharide (LPS)-stimulated differentiation of pro-inflammatory (M1) macrophage subsets, and notably reduce the reactive oxygen species (ROS) generation, as well as obviously decrease inflammatory cytokine release. The in vivo animal studies showed that the CS-PVA-ANE nanofiber mats promoted the healing of diabetic wounds by significantly enhancing wound closure rates, accelerating excellent angiogenesis, promoting re-epithelization and collagen matrix deposition throughout all stages of wound healing. The present study demonstrated that CS-PVA-ANE nanofiber mats could effectively shorten the wound-healing time by inhibiting inflammatory activity, which makes them promising candidates for the treatment of hard-to-heal wounds caused by diabetes.

Evaluation of Clinical Practice Guidelines on Fall Prevention and Management for Older Adults: A Systematic Review.

Importance: With the global population aging, falls and fall-related injuries are ubiquitous, and several clinical practice guidelines for falls prevention and management for individuals 60 years or older have been developed. A systematic evaluation of the recommendations and agreement level is lacking. Objectives: To perform a systematic review of clinical practice guidelines for falls prevention and management for adults 60 years or older in all settings (eg, community, acute care, and nursing homes), evaluate agreement in recommendations, and identify potential gaps. Evidence Review: A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-analyses statement methods for clinical practice guidelines on fall prevention and management for older adults was conducted (updated July 1, 2021) using MEDLINE, PubMed, PsycINFO, Embase, CINAHL, the Cochrane Library, PEDro, and Epistemonikos databases. Medical Subject Headings search terms were related to falls, clinical practice guidelines, management and prevention, and older adults, with no restrictions on date, language, or setting for inclusion. Three independent reviewers selected records for full-text examination if they followed evidence- and consensus-based processes and assessed the quality of the guidelines using Appraisal of Guidelines for Research & Evaluation II (AGREE-II) criteria. The strength of the recommendations was evaluated using Grades of Recommendation, Assessment, Development, and Evaluation scores, and agreement across topic areas was assessed using the Fleiss κ statistic. Findings: Of 11 414 records identified, 159 were fully reviewed and assessed for eligibility, and 15 were included. All 15 selected guidelines had high-quality AGREE-II total scores (mean [SD], 80.1% [5.6%]), although individual quality domain scores for clinical applicability (mean [SD], 63.4% [11.4%]) and stakeholder (clinicians, patients, or caregivers) involvement (mean [SD], 76.3% [9.0%]) were lower. A total of 198 recommendations covering 16 topic areas in 15 guidelines were identified after screening 4767 abstracts that proceeded to 159 full texts. Most (≥11) guidelines strongly recommended performing risk stratification, assessment tests for gait and balance, fracture and osteoporosis management, multifactorial interventions, medication review, exercise promotion, environment modification, vision and footwear correction, referral to physiotherapy, and cardiovascular interventions. The strengths of the recommendations were inconsistent for vitamin D supplementation, addressing cognitive factors, and falls prevention education. Recommendations on use of hip protectors and digital technology or wearables were often missing. None of the examined guidelines included a patient or caregiver panel in their deliberations. Conclusions and Relevance: This systematic review found that current clinical practice guidelines on fall prevention and management for older adults showed a high degree of agreement in several areas in which strong recommendations were made, whereas other topic areas did not achieve this level of consensus or coverage. Future guidelines should address clinical applicability of their recommendations and include perspectives of patients and other stakeholders.

Seeking care from a traditional healer after injury in Sudan: an exploratory cross-sectional analysis.

BACKGROUND: Seeking care from traditional healers for injury is a common practice in low- and middle-income countries, including Sudan. As little is known about specific patterns of the practice in the country, we aimed to investigate associated factors and the role of professional injury care availability. METHODS: We used Sudan Household Health Survey 2010 data from a national stratified multistage cluster sample of 15 000 households. A multivariable Poisson regression (PR) model with robust variance was used to test potential associations of receiving care from a traditional healer in the first week after injury with age, gender, urban/rural residence, wealth index, educational attainment, cause of injury, time of injury occurrence and state-level injury-care bed density. RESULTS: Of 1432 injured participants who sought some form of healthcare, 38% received care from a traditional healer. A significant negative association was found with educational attainment, age and wealth. The association between injury-care bed density and receiving care from a traditional healer was consistently evident only when the injury was caused by a road traffic accident (PR = 0.90, 95% CI 0.85 to 0.96). CONCLUSIONS: Merely increasing the affordability or availability of injury care facilities may not impact reliance on traditional healers for all causes of injury. Therefore, injury care policies need to consider the role of traditional healers as part of the healthcare system.

Decreasing Trends in Road Traffic Injury Incidence and Mortality in Nigeria: A Ten-Year Analysis.

BACKGROUND: Road traffic accidents constitute a significant public health burden in Nigeria. In this study, we aim to (1) characterize the temporal burden of road traffic injury (RTI) and mortality rates in Nigeria over a decade, (2) identify regional RTI incidence, mortality trends, and high-risk regions, and (3) assess the impact of state population on injury and mortality. MATERIALS AND METHODS: We retrospectively reviewed aggregate state-level RTI incidence and mortality counts reported by the Federal Road Safety Corps from January 2001 through December 2010. We also reviewed population data from the National Population Commission. In addition to national analyses, regional analyses were performed in Nigeria's six geopolitical zones and one Federal Capital Territory (FCT). Regression analysis was also performed to determine the relationship between population and RTI incidence and mortality. RESULTS: The national median RTI incidence and mortality rates declined by 53% and 75%, respectively, between 2001 and 2010. Analysis by geopolitical zone yielded the greatest increases for both injury and mortality in the FCT and the greatest decreases for both in the South-South region. The average geopolitical zone, apart from the FCT, experienced a 24% decrease in the incidence rate and a 69% decrease in the mortality rate. An analysis of variance, run to assess potential differences in RTI incidence and mortality rates by state population, yielded significant values of P = 0.0023 for injury and P = 0.0002 for mortality. CONCLUSIONS: Acknowledging the potential for underreporting, a more holistic surveillance approach would generate more accurate data for future policy creation to improve clinical outcomes.

Friends with malefit. The effects of keeping dogs and cats, sustaining animal-related injuries and Toxoplasma infection on health and quality of life.

Many studies show that keeping cats and dogs has a positive impact on humans' physical and mental health and quality of life. The existence of this "pet phenomenon" is now widely discussed because other studies performed recently have demonstrated a negative impact of owning pets or no impact at all. The main problem of many studies was the autoselection-participants were informed about the aims of the study during recruitment and later likely described their health and wellbeing according to their personal beliefs and wishes, not according to their real status. To avoid this source of bias, we did not mention pets during participant recruitment and hid the pet-related questions among many hundreds of questions in an 80-minute Internet questionnaire. Results of our explorative study performed on a sample of 10,858 subjects showed that liking dogs has a weak positive association with quality of life. However, keeping pets, especially cats, and even more being injured by pets, were strongly negatively associated with many facets of quality of life. Our data also confirmed that infection by the cat parasite Toxoplasma had a very strong negative effect on quality of life, especially on mental health. However, the infection was not responsible for the observed negative effects of keeping pets, as these effects were much stronger in 1,527 Toxoplasma-free subjects than in the whole population. Any cross-sectional study cannot discriminate between a cause and an effect. However, because of the large and still growing popularity of keeping pets, the existence and nature of the reverse pet phenomenon deserve the outmost attention.

Local dermal application of a compound lidocaine cream in pain management of cancer wounds.

The aim of this study was to explore the analgesic effect of local application of compound lidocaine/prilocaine cream on cancer wounds during wound care in order to reduce the amount of morphine intake or completely replace the systemic morphine administration and optimize the protocol for cancer wound pain management. All patients were enrolled with a visual analog scale (VAS) pain score ≥4. Before wound care, 60 patients were randomly divided into 2 groups of 30 each: morphine group (10 mg tablet); topical 5% compound lidocaine cream group (0.2 g/cm2). VAS scores, heart rate, and Kolcaba comfort level were recorded for the two groups 10 min before and 10, 15, 20, and 25 min after wound care and data were analyzed statistically. The means for the pain score and heart rate of the topical lidocaine/prilocaine cream group were lower than those of the morphine group (P<0.01) and the Kolcaba comfort level was higher (P<0.01). Local dermal application of the compound lidocaine cream can be used as an alternative to the systemic morphine administration in cancer wound care for its safety and effectiveness. In addition, it can improve the patients' comfort and quality of life.

Injury in yoga asana practice: Assessment of the risks.

BACKGROUND: The risk of injury from modern yoga asana practice is poorly characterized in the scientific literature, but anecdotal reports in the lay literature and press have posed questions about the possibility of frequent, severe injuries. DESIGN: We performed a cross-sectional survey of yoga asana participants assessing their experience with yoga-related injury, using a voluntary convenience sample. RESULTS: A total of 2620 participants responded to our survey. Seventy-nine percent were between ages 31 and 60 and 84% were female. The majority of respondents lived in North America or Europe. Forty-five percent of participants reported experiencing no injuries during the time they had been practicing yoga. Of those who did experience an injury from asana practice, 28% were mild (e.g., sprains or nonspecific pains not requiring a medical procedure, with symptoms lasting less than 6 months) and 63% were moderate (e.g., sprains or nonspecific pains not requiring a medical procedure, with symptoms lasting from 6 months to 1 year). Only 9% of those reporting injuries (4% of the total sample) had a severe injury. The strongest predictors for increased probability of reporting an injury over a lifetime of yoga practice were greater number of years of practice (p < .0001) and teaching yoga (p = .0177). Other aspects of participant demographics or yoga practice habits were not related to likelihood of reporting a yoga-related injury. CONCLUSIONS: We found the number of injuries reported by yoga participants per years of practice exposure to be low and the occurrence of serious injuries in yoga to be infrequent compared to other physical activities, suggesting that yoga is not a high-risk physical activity. More work is needed to clarify the causal relationships between the yoga participant characteristics, the asana practice style, and the risk of significant injury.

Holistic management of malignant wounds in palliative patients.

Malignant wounds are a complication of cancer, and usually occur in those individuals with advanced disease. When healing ceases to be the goal, treatment is centred around symptom control and improving quality of life. Caring for individuals with malignant wounds presents challenges for patients, their families and nurses alike. This article discusses the holistic management of malignant wounds, with an emphasis on the control of both physical and psychosocial symptoms of wound management, as well as the impact that this may have on all those involved. Common physical symptoms of malignant wounds include malodour, bleeding, pain, exudate and pruritis. Psychosocial symptoms may result in social isolation and depression. All these symptoms have a huge impact, not only on patients and their families, but also on healthcare professionals both during and after care. Managing these symptoms requires a multidisciplinary approach to facilitate the best possible outcomes for patients and their caregivers.

Adverse effects of yoga: a national cross-sectional survey.

BACKGROUND: While yoga is increasingly used for health purposes, its safety has been questioned. The aim of this cross-sectional survey was to analyze yoga-associated adverse effects and their correlates. METHODS: A cross-sectional anonymous national online survey among German yoga practitioners (n = 1702; 88.9% female; 47.2 ± 10.8 years) was conducted from January to June 2016. Participants were queried regarding their yoga practice, i.e. yoga styles used, length and intensity of yoga practice, practice patterns, and whether they had experienced acute or chronic adverse effects of their yoga practice. Independent predictors of acute or chronic adverse effects were identified using multiple logistic regression analyses. RESULTS: Ashtanga yoga (15.7%), traditional Hatha yoga (14.2%), and Sivananda yoga (22.4%) were the most commonly used yoga styles. 364 (21.4%) yoga users reported 702 acute adverse effects, occurring after a mean of 7.6 ± 8.0 years of yoga practice. The most commonly reported yoga practices that were associated with acute adverse effects were hand-, shoulder- and head stands (29.4%). Using Viniyoga was associated with a decreased risk of acute adverse effects; practicing only by self-study without supervision was associated with higher risk. One hundred seventy-three participants (10.2%) reported 239 chronic adverse effects. The risk of chronic adverse effects was higher in participants with chronic illnesses and those practicing only by self-study without supervision. Most reported adverse effects concerned the musculoskeletal system. 76.9% of acute cases, and 51.6% of chronic cases reached full recovery. On average 0.60 injuries (95% confidence interval = 0.51-0.71) per 1000 h of practice were reported, with Power yoga users reporting the highest rate (1.50 injuries per 1000 h; 95% confidence interval = 0.98-3.15). CONCLUSIONS: One in five adult yoga users reported at least one acute adverse effect in their yoga practice, and one in ten reported at least one chronic adverse effect, mainly musculoskeletal effects. Adverse effects were associated with hand-, shoulder- and head stands; and with yoga self-study without supervision. More than three quarters of of cases reached full recovery. Based on the overall injury rate per 1000 practice hours, yoga appears to be as safe or safer when compared to other exercise types.

Differences in the epidemiology of out-of-hospital and in-hospital trauma deaths.

BACKGROUND: Trauma is a leading cause of mortality. Holistic views of trauma systems consider injury as a public health problem that requires efforts in primary, secondary and tertiary prevention. However, the performance of trauma systems is commonly judged on the in-hospital mortality rate. Such a focus misses opportunities to consider all deaths within a population, to understand differences in in-hospital and out-of-hospital trauma deaths and to inform population-level injury prevention efforts. The aim of this study was to provide an epidemiological overview of out-of-hospital and in-hospital trauma deaths in a geographically-defined area over a 10-year period. METHODS: We performed a population-based review of out-of-hospital and in-hospital trauma deaths over the period of 01 July 2006 to 30 June 2016 in Victoria, Australia, using data from the National Coronial Information System and the Victorian State Trauma Registry. Temporal trends in population-based incidence rates were evaluated. RESULTS: Over the study period, there were 11,246 trauma deaths, of which 71% were out-of-hospital deaths. Out-of-hospital trauma deaths commonly resulted from intentional self-harm events (50%) and transport events (35%), while in-hospital trauma deaths commonly resulted from low falls (≤1 metre) (50%). The incidence of overall trauma deaths did not change over the study period (incidence rate ratio 0.998; 95%CI: 0.991, 1.004; P = 0.56). CONCLUSIONS: Out-of-hospital deaths accounted for most trauma deaths. Given the notable differences between out-of-hospital and in-hospital trauma deaths, monitoring of all trauma deaths is necessary to inform injury prevention activities and to reduce trauma mortality. The absence of a change in the incidence of both out-of-hospital and in-hospital trauma deaths demonstrates the need for enhanced activities across all aspects of injury prevention.

Skin lesions and traditional folk practices: a medico-legal perspective.

The correct assessment of signs of abuse on the skin is a challenge of utmost importance for both clinical and forensic applications. This review aims to investigate how differing cultural behaviors influence the perception of abuse, focusing on the need for a multidisciplinary approach and investigation. A literature search for articles that discussed folk practices from a forensic perspective was performed; articles with reference to abuse in the description of the main folk healing techniques and with reference to the differential diagnosis between physical abuse and skin injuries due to folk healing techniques were selected. A synoptic table of all skin injuries produced by folk healing techniques, divided by geographical area, was created. This table can be used as a tool for the thorough assessment of typical signs detectable on the skin, thus aiding in a differential diagnosis. The first approach to the patient represents a crucial step toward the identification of abuse; forensic practitioners ought to be aware of the existence of folk healing techniques which may mimic signs that can be interpreted as physical abuse in children and adults.

Local dermal application of a compound lidocaine cream in pain management of cancer wounds

The aim of this study was to explore the analgesic effect of local application of compound lidocaine/prilocaine cream on cancer wounds during wound care in order to reduce the amount of morphine intake or completely replace the systemic morphine administration and optimize the protocol for cancer wound pain management. All patients were enrolled with a visual analog scale (VAS) pain score ≥4. Before wound care, 60 patients were randomly divided into 2 groups of 30 each: morphine group (10 mg tablet); topical 5% compound lidocaine cream group (0.2 g/cm2). VAS scores, heart rate, and Kolcaba comfort level were recorded for the two groups 10 min before and 10, 15, 20, and 25 min after wound care and data were analyzed statistically. The means for the pain score and heart rate of the topical lidocaine/prilocaine cream group were lower than those of the morphine group (P<0.01) and the Kolcaba comfort level was higher (P<0.01). Local dermal application of the compound lidocaine cream can be used as an alternative to the systemic morphine administration in cancer wound care for its safety and effectiveness. In addition, it can improve the patients' comfort and quality of life.

Assessment and treatment of trichotillomania (hair pulling disorder) and excoriation (skin picking) disorder.

Recommendations are provided for the assessment and treatment of trichotillomania (hair pulling disorder, or HPD) and excoriation disorder (skin picking disorder, or SPD), two body-focused repetitive behavior (BFRB) disorders, based on their severity, comorbidities, and behavioral style. Habit reversal training (HRT) and stimulus control are first-line behavioral treatments that can be used in cases of all severity levels and may be particularly helpful when pulling or picking is performed with lowered awareness/intention. Acceptance and commitment therapy (ACT) and dialectical behavior therapy (DBT) are behavioral treatments that can be employed to augment HRT/stimulus control, especially when negative emotions trigger the pulling or picking. There are currently no FDA-approved pharmacologic treatments for HPD or SPD, though certain medications/supplements have shown varying degrees of efficacy in trials. N-acetylcysteine (NAC) should be considered for all severity levels and styles given its moderate gain/low side effect profile. Other pharmacologic interventions, including selective serotonin reuptake inhibitors (SSRIs), should be considered in cases with significant comorbidities or previous behavioral/NAC treatment failure.

High dose oral vitamin C and mesenchymal stem cells aid wound healing in a diabetic mouse model.

OBJECTIVE: This study sought to determine the effects of oral vitamin C (VitC) and mesenchymal stem cells (MSCs) on wound healing in diabetic nude mice. METHOD: Bilateral, full-skin thickness wounds were created as an in vivo wound model in BALB/C diabetic nude mice. The mice were separated into five groups: control (CON); diabetes mellitus (DM, from a streptozotocin injection); DM treated with MSCs (DM+MSCs); DM treated with VitC (DM+VitC), and DM treated with MSCs and VitC (DM+MSCs+VitC). After wounding, daily oral-feeding of high dose VitC (1.5g/l) was administered, and a single dose of MSCs (1x106 cells) was given topically using matrix gel application to the wounded area. RESULTS: At day seven, the lowest rate of wound healing, in terms of percentage of wound closure, appeared in the DM group, as compared with the CON and all other treatment groups (mean percentage of wound closure and standard deviation), CON=75.94±7.09%; DM=55.65±9.59%; DM+MSCs=78.57±6.46%; DM+VitC=77.52±3.31%; and DM+MSCs+VitC=84.61±2.87%, p≤0.05. At day 14 post-wounding, the combination of oral high dose VitC and MSCs accelerated wound healing (91.44±3.19%, p≤0.05). In addition, the highest capillary density in DM+MSCs+VitC was obtained at 14 days post-wounding (29.49±7.30%, p≤0.05). CONCLUSION: The findings of this study highlight the possibility of using oral high dose VitC in adjunct to MSCs to increase angiogenesis and accelerate diabetic wound healing in an animal model. This novel therapeutic approach should be studied further to test if it could be a useful adjunct of existing therapies to prevent infection and amputation in patients with diabetes.

Development of a contaminated ischemic porcine wound model and the evaluation of bromelain based enzymatic debridement.

OBJECTIVES: There are no well accepted animal models of chronic wounds, limiting advances in understanding and treatment of chronic ulcers. We developed a porcine wound model which combines multiple factors involved in chronic wounds to create a contaminated necrotic eschar and evaluated the debriding efficacy of a novel bromelain based enzymatic debriding agent (EscharEx). METHODS: Contaminated ischemic wounds were created on the flanks of domestic pigs by 'sandwiching' the skin between 2 'O' rings (1 placed on the surface of the skin and the other underneath the skin) for 24h prior to dermatomal excision of the necrotic eschar and its contamination with Staphylococcus aureus and Candida albicans. After confirming the development of infected eschars, additional animals were used to compare the effects of daily application of topical EscharEx or its hydrating vehicle on eschar debridement as a control. RESULTS: In all cases, application of the 'O' rings resulted in full thickness necrotic ecshars with invasive infections, which did not reepithelialize and sloughed off spontaneously within 14-21 days. All wounds reepithelialized within 28-42 days forming contracted scars. All EscharEx treated eschars were completely debrided within 7-9 days, while no debridement was evident in eschars treated with the control gel. CONCLUSIONS: Our model simulates the initial phase of chronic wounds characterized by a contaminated necrotic eschar allowing evaluation of wound debriding agents, and that a bromelain-based debriding agent completely debrides the contaminated necrotic eschars within one week in this model.

Strychnos pseudoquina modulates the morphological reorganization of the scar tissue of second intention cutaneous wounds in rats.

Natural substances are used in folk medicines to treat injuries. Strychnos pseudoquina has scarring, antipyretic, and antimalarial actions. The present study aimed to analyze the effect of S. pseudoquina on cutaneous wound healing in rats. The S. pseudoquina extract was submitted to phytochemical prospection. The levels of flavonoids and total phenolic compounds in the extract were 50.7 mg/g and 2.59 mg/g, respectively. Thirty Wistar rats were individualized in cages with food and water ad libitum (registration no. 730/2014). After anesthesia, three circular wounds (12mm diameter) were made in the animals, which were randomly separated into five treatments: Sal, saline; VO, ointment vehicles (lanolin and Vaseline); SS, positive control (silver sulfadiazine 1%); LE 5, freeze-dried extract 5%; and LE 10, lyophilized extract 10%. The animals were treated with the ointment daily for 21 days. Every seven days, the area and the rate of wound contraction were evaluated. Tissue samples were removed for histopathological analysis of the number of mast cells, elastic and collagen fibers, and biochemical analyses, quantification of malondialdehyde (MDA), carbonylated proteins (PCN), superoxide dismutase (SOD), catalase (CAT), transforming growth factor ß (TGF-ß), Interleukin 10 (IL-10) and tumor necrosis factor (TNF). The number of mast cells, collagen and elastic fibers in the rat wounds were higher in the treatments with the plant. The extract also stimulated the activity of antioxidant enzymes, particularly SOD, presenting high levels, and maintained low levels of PCN. The TGF-ß and IL-10 concentration was higher in the LE5 and LE10 treatment of the extract than in the Sal, OV and SS treatments on day 7. The ointment based on S. pseudoquina closed the wound faster and accelerated wound healing in animals.

Identifying Pain and Effects on Quality of Life from Chronic Wounds Secondary to Lower-Extremity Vascular Disease: An Integrative Review.

GENERAL PURPOSE: To provide information to enable better assessment and management of patients with lower extremity vascular disease (LEVD) chronic wound pain. TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After completing this continuing education activity, you will be able to: ABSTRACT: A lack of wound pain validation and provider understanding about the effect of pain on quality of life are the biggest barriers to pain management for patients with chronic wound pain. There is also a need for a holistic, validated pain assessment tool for these patients. This is an integrative review of the literature intended to identify gaps in pain identification and (re)assessment for patients with chronic wounds related to lower-extremity vascular disease.

A Case Study of the NCRP 156 Wound Model of Embedded DU Using Data From Urine Uranium Concentrations of Wounded Veterans.

Depleted uranium (DU) munitions were initially used by the United States (U.S.) military during the first Persian Gulf War in 1991 in order to penetrate heavily armored vehicles. However, as a result of friendly fire, several U.S. military personnel received intakes from DU munitions. One of the ongoing concerns for these wounded veterans is the potential long-term exposure received from DU embedded fragments. The United States Army Institute of Public Health (AIPH) is the first laboratory that analyzes the urine bioassays from Army Soldiers that are injured with DU fragments. The United States Air Force School of Aerospace Medicine also evaluates bioassays from DU injuries. The urine bioassay data collected by AIPH was evaluated using the NCRP 156 wound model coefficients for the DU-Wafer, Fragment, and Particle models. The maximum likelihood method was used in the Integrated Modules for Bioassay Analysis (IMBA-PPAE) to calculate the estimates of intake and tissue doses. Evaluating the three models for wound retention, the DU-Wafer and Fragment model yielded a credible fit to the bioassay data. Comparing the two models, the DU-Wafer model fits the data better than the Fragment model when comparing their autocorrelation coefficient and chi-squared values of (P 1.73 × 10, c 4.83 × 10), (P 2.01 × 10, c 1.09), respectively. This evaluation supports the validity of both the DU-wafer model as well as the default fragmentation model proposed by NCRP 156.

Musculoskeletal Injuries in Yoga.

While yoga has been widely studied for its benefits to many health conditions, little research has been performed on the nature of musculoskeletal injuries occurring during yoga practice. Yoga is considered to be generally safe, however, injury can occur in nearly any part of the body-especially the neck, shoulders, lumbar spine, hamstrings, and knees. As broad interest in yoga grows, so will the number of patients presenting with yoga-related injuries. In this literature review, the prevalence, types of injuries, forms of yoga related with injury, specific poses (asanas) associated with injury, and preventive measures are discussed in order to familiarize practitioners with yoga-related injuries.

Injuries and other adverse events associated with yoga practice: A systematic review of epidemiological studies.

OBJECTIVES: To systematically assess the prevalence of yoga-associated injuries and other adverse events in epidemiological studies. DESIGN: Systematic review of observational studies. METHODS: Medline/PubMed, Scopus, the Cochrane Library, and IndMed were searched through October 2016 for epidemiological studies assessing the prevalence of adverse events of yoga practice or comparing the risk of any adverse events between yoga practitioners and non-yoga practitioners. RESULTS: Nine observational studies with a total 9129 yoga practitioners and 9903 non-yoga practitioners were included. Incidence proportion of adverse events during a yoga class was 22.7% (95% confidence interval [CI]=21.1%-24.3%); 12-months prevalence was 4.6% (95%CI=3.8%-5.4%), and lifetime prevalence ranged from 21.3% (95%CI=19.7%-22.9%) to 61.8% (95%CI=52.8%-70.8%) of yoga practitioners. Serious adverse events occurred in 1.9% (95%CI=1.4%-2.4%). The most common adverse events related to the musculoskeletal system; the most common injuries were sprains and strains. Compared to non-yoga practitioners, yoga practitioners had a comparable risk of falls (odds ratio [OR]=0.90; 95%CI=0.76-1.08), and falls-related injuries (OR=1.04; 95%CI=0.83-1.29), and higher risk of meniscus injuries (OR=1.72; 95%CI=1.23-2.41). CONCLUSIONS: A considerable proportion of yoga practitioners experienced injuries or other adverse events; however most were mild and transient and risks were comparable to those of non-yoga practitioners. There is no need to discourage yoga practice for healthy people. People with serious acute or chronic illnesses should seek medical advice before practicing yoga.